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Did you know the latest information on the new Dragon Medical One release?
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VIDEO: Dragon Medical One Product Overview
(1:31 minutes) |
On April 27, 2016, Nuance launched Dragon Medical One (DM One), version 3.0, providing cloud-based, clinical speech recognition through a secure connection to the Nuance Healthcare Cloud. DM One clients will receive Dragon Medical One as a no-cost upgrade.
Upgrade kits are available for both ClickOnce and Standalone installations.
DM One, this latest version of our cloud platform:
- Introduces an updated speech engine for greater accuracy
- Brings exciting new features/capabilities to the DM One Desktop Application (formerly known as Dragon Medical Direct)
- Extends each clinician's speech profiles beyond just their EHR workflow
- Delivers full access to Dragon Medical Analytics.
New Features
NMS LocalAuthenticator LDAP Authentication
In addition to the Nuance Management Server (NMS) CallForwarder,
DM One now supports the NMS LocalAuthenticator component to validate credentials against LDAP/AD servers when logging on.
Nuance Healthcare ID (NHID)
NHID provides clinicians with voice access to resources way beyond just their EHR. NHID personalizes the clinician's experience by offering access to different speech-enabled workflows from a growing catalog of mobile productivity applications and services as they emerge from numerous vendors. All this at no additional cost above and beyond the initial DM One licensing fee.
NHID allows clinicians to use their single account, and their associated personal speech profile with all their customizations,
to maintain continuity of the user's speech recognition experience across this eco-system of healthcare workflows, including secure communication, care coordination, clinical reference, and medical education tools.
User registration is a one-time process and can be completed upon first login to the DM One Desktop Application.
Dragon Medical Analytics
Dragon Medical Analytics provides access to individual and site-wide usage metrics and trends so you can optimize clinician efficiency, productivity, and workflows. Our hosted speech services are deployed in an Active/Active configuration, which not only provides full redundancy, but also ensures maximum performance as users are routed to the nearest data center based on least latency. As a result of this dynamic routing optimization, the speech analytics usage data for your organization may be distributed across multiple data centers.
Improvements
Improvements offered with the version 3.0 release of DM One include:
- Communication with Nuance Management Server will only use port 443. Additional non-standard ports (like 8010) are no longer required to be opened for communication.
- The logon procedure has been improved, including significantly reducing CPU utilization for the logon screen
while navigating and filling out fields with their voice. End users can now continue speaking without the need to wait for the field to be selected.
- Auto-text field markers have been customized by end users and are now shared with applications that integrate the SpeechAnywhere Services client SDK. This enables end users to share auto-texts with fields across different Nuance platforms.
- End users can now use additional voice commands to format text; "bold that" "normal that" "underline that" and "italicize that". These commands have been added as alternatives to the existing voice commands.
Upgrade Kits
ClickOnce Installation Package
If you have previously allowed your clinicians to self-install Dragon Medical Direct through the ClickOnce installation package, it is important to note that their installation will not automatically update to DM One. In order to upgrade to DM One, your users will need to follow these simple steps.
- Uninstall Dragon Medical Direct by using the Add/Remove Programs from the Control Panel.
- Use the link below to access and install the software from our new ClickOnce landing page.
View the ClickOnce Installation Download Page
Standalone XCOPY or MSI Installations
If you have previously deployed Dragon Medical Direct on a virtual server and/or as a desktop push installation, you will need to follow these simple steps to upgrade to the DM One Desktop Application.
- Uninstall Dragon Medical Direct.
- Download the XCOPY or MSI installation packages from the link below.
Also, for customers using the Standalone installation method, see the link below for resources including:
Frequently Asked Questions
Here are a list of current FAQs that will be updated as required.
- How will this affect our current installation/deployment?
If you are not upgrading immediately. Your configuration will continue to function as before. However, please plan and schedule and update in the coming days to ensure new features are available to the end-users.
- Most Direct releases are no longer supported after 1 year. When will the current/last released version of Direct cease to be supported?
Any version older than 2.0 will be affected.
- Is it required to upgrade? If so, by when?
It is NOT required immediately. However customers are encouraged to upgrade quickly to use the most stable version, and enjoy the newest features.
- Do BOTH ClickOnce and Standalone have to be upgraded/reinstalled? (The letter mentions only ClickOnce, but it would seem like both would have to be)
ClickOnce versions need to be re/installed. They will not auto-upgrade as they would otherwise. That is why these are mentioned.
Standalone and MSI packages will need to be "pushed" by the customers as usual.
- Does this upgrade affect existing configurations and will these configurations have to be reset (ex: Imprivata/SSO/AD)?
No, with one exception.
DMOne will start communicating with https://nms.nuancehdp.com over port 443 instead of 8010. Usually 443 is not blocked by firewalls,
but customers will need to make sure.
- Is the registration of the Nuance Healthcare ID (NHID) required to use DM One?
No. It is not required. However end-users are encouraged to do this step to enjoy the benefits of NHID.
- What exactly does the Nuance Healthcare ID tie together and what does it affect?
[Information is pending].
- Is DM One's "Dragon Medical Analytics" just a separate/new tab in the NMC? If an org has both DMOne and DMNE, do the analytics look at both applications?
DMNE analytics are different. DM One / DMembedded (formerly SpeechAnywhere Services) analytics are within the same location (cloud).
- Is the installation/configuration of DM One the same as Direct?
Yes. Please follow the instructions for this first DM One transition.
- Is this upgrade out to everyone on the 26th, or is it already out and just notifications/welcome kits are being sent on 4/26?
It has been released on April 27th for general availability.
- Is DM One Desktop Application's new word training feature: A) mirroring the NE function where it takes the sound-byte, or B) learning from corrections made manually on screen?
It is not an exact mirror. However the end users can acoustically train a word. Learning/adaptation from corrections is already taking place in the background (cloud).
To learn more and to keep current with any changes to this topic, log in to iSupport and search for solution 17066: Dragon Medical One - Introduction and Resources.
For more information on configuring DM One, please see the Installation and Administration Guide
For more information on the NMS LocalAuthenticator feature, refer to the NMS/NMC documentation.
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Did you know what networking tools can determine if network ports are open?
Customers using Dragon Medical Network Edition (DMNE) and Dragon Medical One (formerly Direct) products are required to open specific network ports for the successful installation and operation of these Nuance products. The following networking tools can help to determine if network ports are open.
 NOTE: These networking tools should be used by technically competent personnel.
Network Telnet Client
The Telnet Client is a widely available utility that can be used to determine whether required network ports are opened for Nuance products.
Telnet is a session layer protocol used on the Internet or local area networks to provide a bidirectional interactive text-oriented communication facility using a virtual terminal connection. User data is interspersed in-band with Telnet control information in an 8-bit byte oriented data connection over the Transmission Control Protocol (TCP).
For example, use the Telnet commands below to check whether network ports are open for the Dragon Medical One 2.x (formerly Direct - port 8010) and for Dragon Medical One 3.x and higher (port 443):
- Enable the Telnet Client on the workstation where the Dragon Medical One application is being installed.
The Telnet Client is not installed by default on Windows 7, Windows Server 2008 R2, Windows Vista, or Windows Server 2008. The procedures to install Telnet Client vary based on the operating system used. Refer to the URL below for procedures on installing the Telnet Client:
- At a command prompt, type:
telnet nsa.nuancehdp.com 8010
telnet nms.nuancehdp.com 443
telnet nms1.nuancehdp.com 443
telnet nms2.nuancehdp.com 443
telnet sas.nuancehdp.com 443
telnet sas1.nuancehdp.com 443
telnet sas2.nuancehdp.com 443
telnet pmm.nuancehdp.com 443
telnet pmm1.nuancehdp.com 443
telnet pmm2.nuancehdp.com 443
telnet speechanywhere.nuancehdp.com 443
telnet speechanywhere1.nuancehdp.com 443
telnet speechanywhere2.nuancehdp.com 443
Pathping Command
Also, for testing RTT (round-trip time), use the following pathping command:
PowerShell Script
Please access the iSupport solution below and follow the instructions for using PowerShell scripts that can be adapted and pasted into a PowerShell Integrated Scripting Environment (ISE), in order to test if network ports are open.
NOTE: PowerShell scripts should be run be technically-competent personnel who understand this topic.
To learn more and to keep current with any changes to this topic, log in to iSupport and search for solution 16824: Networking Tools to determine if network ports are open (Telnet / PowerShell).
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Did you know how DMNE License and Device Usage reports work?
Customers using Dragon Medical Network Edition (DMNE) reporting through the Nuance Management Console (NMC) should know the following characteristics for the reports listed below.
License Usage Report
The License Usage Report will not show an individual's number of logins over the time specified.
For example, it will not show that Dr. Smith logged in 5 times last week. However, it will show the total accumulated login count for Dr. Smith over the life of the account if Dr. Smith logged in during the time specified. If Dr. Smith did not login during the specified time frame then the report will show "0".
The report merely looks at the time specified, then checks that against the last login date, if the last login date is within the specified date range of the report, then it display totals.
Device Usage Report
The Device Usage Report works in the same fashion except with hostnames.
Examples
Date Range: 5/1/2016-5/3/2016
Last Login date: 4/29/2016
Result: Do not display cumulative total count
Date Range: 5/1/2016-5/3/2016
Last Login date: 5/2/2016
Result: Display cumulative total count
To learn more and to keep current with any changes to this topic, log in to iSupport and search for solution 17081: DMNE License and Device Usage reports explained.
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Did you know about updates to our anti-virus recommendations?
Please see the updated sections below.
General Anti-Virus Recommendations for Dragon Medical
 IMPORTANT: This article contains antivirus exclusions. It is important to understand that antivirus exclusions and optimizations increase the attack surface of a system and might expose computers to a variety of real security threats. However, the following guidelines typically represent the best trade-off between security and performance. Nuance does not recommend implementing any of these exclusions or optimizations until rigorous testing has been conducted in a lab environment to thoroughly understand the trade-offs between security and performance. Nuance also recommends organizations to engage their antivirus and security teams to review the following guidelines before proceeding with any type of production deployment.
If organizations choose to exclude particular files or folders as part of real-time or on-access scanning, Nuance recommends scanning the excluded files and folders on a regular basis using scheduled scans. It is recommended to perform scheduled scans during non-business or off-peak hours to mitigate any potential performance impact.
The following anti-virus recommendations are provided for these Dragon Medical products:
- Dragon Medical Network Edition (DMNE)
- Dragon Medical Practice Edition (DMPE)
Nuance recommends installing anti-virus software on all Dragon Medical servers and clients for obvious protection of the customer system from potential downtime due to malware.
However, please note that the following recommended folder, process, and file exclusions should be removed from any anti-virus scans. Observing these recommended exclusions will ensure the proper operation of the DMNE components.
DMPE Client Exclusions
Ensure that the following Dragon Medical Practice Edition (DMPE) Client anti-virus folder, process, and file exclusions are provided for on all Windows workstations where the DMPE client is running.
IMPORTANT: All exclusions must be applied to cover all subordinate folders, sub-folders and files for the directory paths listed below.
Windows XP
C:\Program Files\Nuance
C:\Program Files\Common Files\Nuance
C:\Documents and Settings\All Users\Application Data\Nuance
C:\Documents and Settings\<Windows user>\Application Data\Nuance
Windows Vista / 7 / 8
(32-bit)
C:\Program Files\Nuance
C:\Program Files\Common Files\Nuance
C:\ProgramData\Nuance
C:\Users\<Windows user>\AppData\Roaming\Nuance\
(64-bit)
C:\Program Files (x86)\Nuance
C:\Program Files (x86)\Common Files\Nuance
C:\ProgramData\Nuance
C:\Users\<Windows user>\AppData\Roaming\Nuance\
Profile Local Cache
Profile local cache location if a custom path other than default below has been defined.
(Windows 7/8) C:\ProgramData\Nuance\NaturallySpeaking12\RoamingUsers
(Windows XP) C:\Documents and Settings\All Users\Application Data\Nuance\NaturallySpeaking12\RoamingUsers
File Extensions
Exclude files with these extensions:
BD, BIN, DAT, DVC, ENH, GSB, GRM, GRX, INI, LCK, NWV, SIG, SVC, USR, VER, VOC, WAV, XML, LOG,
ini_DGNRenamed, voc_DGNRenamed
Process Executables
Exclude the following client processes from real-time process monitoring (see below for details specific to Bit9):
[Common Files Folder]\Nuance\dgnsvc.exe
[Program Files Folder]\Nuance\NaturallySpeaking12\Program\dnsspserver.exe
[Program Files Folder]\Nuance\NaturallySpeaking12\Program\natspeak.exe
Bit9 uses the terminology "kernel level filters" or "kernel process exclusions" – an example value for the "kernelProcessExclusions" parameter is shown immediately below:
kernelProcessExclusions=
*\Program Files*\Nuance\naturallyspeaking*\natspeak.exe:259967,
*\Program Files*\Nuance\naturallyspeaking*\dnsspserver.exe:259967,
After the exclusions have been added to a client computer using a roaming profile configuration, the steps below are further advised:
- The DMPE client should be closed and the client computer should be rebooted.
- Delete the DMPE client's locally-cached profile (see locations above). This will eliminate any collateral effects from a previous issue that may have been caused by an anti-virus conflict.
To learn more and to keep current with any changes to this complete topic, log in to iSupport and search for solution 15981: Anti-Virus recommendations for Dragon Medical.
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Did you know that McAfee Antivirus can interfere with Dragon Medical operation?
Antivirus applications are a mandatory part of securing any software environment. However, Dragon Medical is particularly sensitive to file locking conditions by other applications and can fail when malware software scans the Dragon Medical User Profile folders.
McAfee Agent Version 4.8.0.1500 Crashes Dragon Medical
McAfee agent, version 4.8.0.1500, reportedly crashes Dragon Medical and other applications. An example of log entries associated with McAfee crash conditions causing application errors follows:
Log Name: Application
Source: Application Error
Date: 8/16/2015 9:20:43 AM
Event ID: 1000
Task Category: Application Crashing Events
Level: Error
Faulting application name: FrameworkService.exe, version: 4.8.0.1500, time stamp: 0x529cb47a
Faulting module name: ntdll.dll, version: 6.1.7601.23072, time stamp: 0x55636469
Faulting application path: C:\Program Files (x86)\McAfee\Common Framework\FrameworkService.exe
Faulting module path: C:\WINDOWS\SysWOW64\ntdll.dll
This crash condition is known to occur for Dragon Medical as well as other applications when the same common DLL files are shared.
The recommendation is that when the McAfee FrameworkService.exe crash condition is presented, check with McAfee for an update to resolve this.
SOLUTION
Additional customers have resolved this issue by applying the McAfee update, version 4.8.0.2001.
McAfee LiveSafe and Real Time Scanning
Multiple customers have reported receiving the error below during dictation. Typically, providers are presented with several of these errors, resulting in having to terminate Dragon Medical. Further, customers were able to duplicate this error after 3-5 dictations.
The dragon.log file presents the following error collection:
15:52:04 ERROR (EngSink): There was a internal system error which will prevent you from saving your user profile. You may be able to continue dictating, but you will not be able to save.
15:52:00 Info: Previous lock from E:\work\1250reldmpe\vdct2\mddict.cpp(3358)
15:52:00 SDAPI Error : Error: [s:\mrec22.100\14666\src\dfutil\realdf.cpp 2195 dfutil\realdf 17] SDUttFile_New: C:\Users\deweyjiv\AppData\Roaming\Nuance\NaturallySpeaking12\results\uttfile-b1.0 (See mrec/doc/client.txt for general documentation on errors.)
15:52:00 Stack: (ThreadID 0x2510)
In cases where the customer was running McAfee LiveSafe antivirus software, turning off the McAfee Real Time Scanning feature resolved the issue and customers were no longer able to duplicate the error.
McAfee Host Data Loss Prevention (DLP)
As part of its normal operation, the McAfee Host Data Loss Prevention (DLP) software scans files used by applications to determine rule eligibility for safe, trusted activity. Dragon Medical can fail when the McAfee Host DLP scans its User Profile folders.
Dragon Medical can display an error message stating the User Profile cannot access User Profile data on systems running the McAfee Host DLP. This would include the Dragon Medical Master or Roaming Profile location.
SOLUTION
If McAfee Host DLP is used, create an Application Definition entry in the McAfee Host DLP for Dragon Medical (natspeak.exe) and set its strategy to trusted:
- Log on to the ePO 4.x console.
- Click Menu > Data Protection > DLP Policy.
- Click Application Definition under Definitions box.
- Create a new Application Definition and type a preferred name.
- Select Executable File Name, type natspeak.exe, and click OK.
- Right click on the new Dragon Medical Application Definition, select Process Strategy and set it to Trusted.
- Click Apply.
- Perform an Agent wakeup call, or manually update the policy using the McAfee Agent.
Click here to refer to McAfee® knowledge base article KB71597: Dragon Naturally Speaking conflict with Host Data Loss Prevention for more information.
To learn more and to keep current with any changes to this topic, log in to iSupport and search for solution 14918: McAfee Antivirus Interferes with Dragon Medical Operation.
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